Articulating spinal rod system

ABSTRACT

An adjustable articulating spinal rod system including a first elongated element secured to a first bone, a second elongated element secured to the spine, and an articulating joint connecting the first and second elongated elements. The articulating joint including a first movable joint, a second movable joint, and at least one locking mechanism. The first movable joint is coupled to the first elongated element and the second movable joint which is also coupled the second elongate element. The first and second movable joints are configured to allow polyaxial movement and rotation of the first elongated element with respect to the second elongated element. The at least one locking mechanism immobilizes the first and second movable joints in the locked position to secure the first elongate element in a position relative to the second elongate element and allow movement and rotation in an unlocked position.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. application Ser. No.14/983,055 filed Dec. 29, 2015, which will issue as U.S. Pat. No.9,717,532 on Aug. 1, 2017, which is a continuation of U.S. applicationSer. No. 14/033,574 filed Sep. 23, 2013, which issued as U.S. Pat. No.9,232,966 on Jan. 12, 2016 and which claims priority benefit under 35U.S.C. §119(e) of U.S. provisional application No. 61/704,728 filed Sep.24, 2012, which are incorporated herein by reference in theirentireties.

TECHNICAL FIELD

The present disclosure relates generally to articulating spinal rodsystems, and specifically to an articulating spinal rod system thatallows the elongated members to be angularly adjusted in multiple planesat an articulating joint. The articulating joint may include a proximaljoint and a distal joint to properly align fixation members with apatient's cervical vertebra and occipital region, cervical-thoracic,thoracic-lumbar, lumbar-sacral spinal regions or in a patient'slumbopelvic spine.

BACKGROUND

During a posterior cervical stabilization procedure the surgeongenerally places screws into the lateral mass of the cervical vertebralbody followed by a titanium rod and set screws. The described posteriorcervical stabilization procedure provides stabilization of the cervicalspine to aid in fusion of one or more levels of the spine. One endsection of the rod is occasionally anchored to a plate attached to theoccipital region in a procedure called occipitocervical stabilization.In occipitocervical stabilization constructs, the rod is characterizedby two sections—a first section that extends over the cervical spine anda second section that connects to the occipital plate at an anglerelative to the first section.

In conventional occipitocervical fixation assemblies, the rod may bepre-bent before placement in the patient to form the angle between thefirst and second sections. Once the rod is bent it may be used toconnect a screw or hook at a cervical vertebrae and an occipital plate.The screw or hook may be placed at C1, C2, C3 or any level caudally.Each rod must be customized for each patient's unique anatomy, thus onerod configuration may not be used for all patients. A number ofvariables vary from patient to patient including the angle between thefirst and second rod sections. Since each patient's anatomy varies apre-bent rod may not match each patient's anatomy precisely when the rodis placed. Further adjustment of the pre-bent rod is therefore regularlyrequired during placement of the fixation assembly and is generallyperformed intraoperatively.

Adjusting a rod prior to and/or during an operation can create stress onthe rod which decreases the fatigue strength of the rod material. If thefatigue strength is reduced significantly, then the integrity of the rodcan be compromised and pose a significant risk to the patient. Inaddition, it may be time consuming and cumbersome to bend a rod prior toor during an operation. The rod bending problems are experienced withoccipitocervical fixation assemblies, as well as other spinal inflectionpoints such as lumbopelvic spine fixation assemblies and other implantsystems featuring elongated elements that are manually configured toconform to specific spatial requirements.

SUMMARY

The drawbacks of conventional implant systems, and the practice ofbending and shaping elongated elements, can be avoided with articulatingassemblies in accordance with the present invention.

Articulating assemblies in accordance with the invention may include anadjustable articulating assembly for implantation in a human or animal.The assembly may include a first elongated element for attachment to afirst bone, and a second elongated element for attachment to a secondbone. A coupling may connect the first and second elongated elements.The coupling may include a moveable joint configured to allow polyaxialmovement of the first elongated element with respect to the secondelongated element. The assembly may further include a locking mechanism.The locking mechanism may be operable in an unlocked condition to permitpolyaxial movement of the first elongated element with respect to thesecond elongated element, and a locked condition to immobilize themovable joint and fix the position of the first elongated element withrespect to the second elongated element.

The present disclosure relates generally to an articulating spinal rodsystem, and more specifically, to an articulating spinal rod systemwhich may include articulating joints. In one aspect, provided herein isan articulating spinal rod system, including a first rod, a second rod,a first articulating joint system, and a second articulating jointsystem. The first rod includes a first elongated element and a secondelongated element and the second rod includes a first elongated elementand a second elongated element. The first articulating joint system isconfigured to couple the first elongated element and the secondelongated element of the first rod. The second articulating joint systemis configured to couple the first elongated element and the secondelongated element of the second rod.

In another aspect, provided herein is an articulating joint mechanismincluding a first rod, a second rod, and a joint assembly configured toengage the first rod and the second rod.

In yet another aspect, provided herein is a method of assembling anarticulating joint system, which includes obtaining a first elongatedelement and a second elongated element. The method may also includealigning a first spherical end with a distal end of the first elongatedelement, placing a first member and a second member of a conicalreceptacle over the first spherical end and the distal end of the firstelongated element, and securing the first member to the second member toform a first joint. The method may further include aligning a secondspherical end with a cavity of a receptacle, the receptacle is coupledto the first spherical end. The method also includes placing a coverelement of the receptacle over the second spherical end and securing thecover element to the cavity to form a second joint. The method includesinserting a hinge member of a pivot assembly into a bearing member, thebearing member being attached to the second spherical end and insertinga pivot pin through the bearing member and the hinge member to rotatablycouple the second elongated member to the bearing member.

These, and other objects, features and advantages of this invention willbecome apparent from the following detailed description of the variousaspects of the invention taken in conjunction with the accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the invention andtogether with the detailed description herein, serve to explain theprinciples of the invention. The drawings are only for purposes ofillustrating preferred embodiments and are not to be construed aslimiting the invention.

FIG. 1 is a truncated perspective view of an articulating spinal rodsystem, in accordance with an aspect of the present invention;

FIG. 2 is a truncated side view of the articulating spinal rod system ofFIG. 1 in a first position, in accordance with an aspect of the presentinvention;

FIG. 3 is a truncated side view of the articulating spinal rod system ofFIG. 1 with the proximal joint in a posterior position, in accordancewith an aspect of the present invention;

FIG. 4 is a truncated side view of the articulating spinal rod system ofFIG. 1 with the proximal joint in an anterior position, in accordancewith an aspect of the present invention;

FIG. 5 is a truncated top view of the articulating spinal rod system ofFIG. 1 showing the medial lateral motion of the proximal joint, inaccordance with an aspect of the present invention;

FIG. 6 is a truncated top isometric view of the articulating spinal rodsystem of FIG. 1 showing rotation of the proximal joint, in accordancewith an aspect of the present invention;

FIG. 7 is a truncated cross sectional side view of the articulatingspinal rod system of FIG. 1, in accordance with an aspect of the presentinvention;

FIG. 8 is a truncated cross sectional side view of the articulatingspinal rod system of FIG. 1 with the proximal joint in a posteriorposition, in accordance with an aspect of the present invention;

FIG. 9 is a truncated cross sectional side view of the articulatingspinal rod system of FIG. 1 with the proximal joint in an anteriorposition, in accordance with an aspect of the present invention;

FIG. 10 is a truncated isometric view of the articulating spinal rodsystem of FIG. 1, in accordance with an aspect of the present invention;

FIG. 11 is a truncated side view of the articulating spinal rod systemof FIG. 1 showing anterior posterior movement of the distal joint, inaccordance with an aspect of the present invention;

FIG. 12 is a truncated top view of the articulating spinal rod system ofFIG. 1 showing the medial lateral movement of the distal joint, inaccordance with an aspect of the present invention;

FIG. 13 is a truncated side view of the articulating spinal rod systemof FIG. 1 showing the pivoting motion of the distal rod, in accordancewith an aspect of the present invention;

FIG. 14 is a truncated isometric view of the articulating spinal rodsystem of FIG. 1 showing the rotation of the distal joint, in accordancewith an aspect of the present invention;

FIG. 15 is a truncated side view of the components of the articulatingspinal rod system of FIG. 1, in accordance with an aspect of the presentinvention;

FIG. 16 is an exploded view of the joint of the articulating spinal rodsystem of FIG. 1, in accordance with an aspect of the present invention;

FIG. 17 is a truncated isometric view of an alternative joint embodimentof an articulating spinal rod system, in accordance with an aspect ofthe present invention;

FIG. 18 is a truncated isometric view of another alternative jointembodiment of an articulating spinal rod system, in accordance with anaspect of the present invention;

FIG. 19 is a front perspective view of the articulating spinal rodsystem of FIG. 1 attached to the skull and spine of a patient, inaccordance with an aspect of the present invention; and

FIG. 20 is a side perspective view of the articulating spinal rod systemof FIG. 1 attached to the skull and spine of a patient, in accordancewith an aspect of the present invention.

DETAILED DESCRIPTION OF EMBODIMENTS

Generally stated, disclosed herein is one embodiment of an articulatingspinal rod system and an articulating joint mechanism. Further, a methodof assembling an articulating joint system is discussed.

In this application, the words proximal, distal, anterior, posterior,medial and lateral are defined by their standard usage for indicating aparticular part or portion of a bone or prosthesis coupled thereto, ordirectional terms of reference, according to the relative disposition ofthe natural bone. For example, “proximal” means the portion of a bone orprosthesis nearest the torso, while “distal” indicates the portion ofthe bone or prosthesis farthest from the torso. As an example ofdirectional usage of the terms, “anterior” refers to a direction towardsthe front side of the body, “posterior” refers to a direction towardsthe back side of the body, “medial” refers to a direction towards themidline of the body and “lateral” refers to a direction towards thesides or away from the midline of the body.

Referring to the drawings, wherein like reference numerals are used toindicate like or analogous components throughout the several views, andwith particular reference to FIGS. 1, 15, 19, and 20, there isillustrated a first exemplary embodiment articulating spinal rod system100. The articulating spinal rod system 100 may be implanted into ahuman or an animal. The articulating spinal rod system 100, as shown inFIGS. 19 and 20, includes two rods 102 each including an articulatingjoint 108. In the illustrated embodiment, as shown in FIGS. 1 and 15,one of the two rods 102 is shown and the other is hidden for ease ofviewing. The two rods 102 include a first elongated element 104 and asecond elongated element 106. The articulating joint 108 connects thefirst elongated element 104 and the second elongated element 106. Thefirst elongated element 104 is attached to a bone fixation device, forexample, an occipital plate 122. The second elongated element 106 issecured to a screw assembly 120 and is truncated for clarity in thedepicted embodiment. The second elongated element 106 may be longer andattached to the patient's spine with multiple anchors 120, such ashooks, screw assemblies, or the like. The second rod 102, not shown, maybe configured identical to the rod 102 including the first elongatedelement 104 and the second elongated element 106 shown in FIG. 1 or in adifferent arrangement.

The articulating joint 108 is configured to allow for polyaxial movementof the first elongated element 104 with respect to the second elongatedelement 106. The articulating joint 108 may also include at least onelocking mechanism, in the illustrated embodiment the articulating joint108 includes a first locking mechanism 110, a second locking mechanism112, and a third locking mechanism 114. The locking mechanisms 110, 112,and 114 may allow for polyaxial movement of the articulating joint 108when in an unlocked condition and when in the locked condition thearticulating joint 108 is immobilized and the positions of the firstelongated element 104 and second elongated element 106 are fixed. Thelocking mechanisms 110, 112, and 114 may include at least one screw. Thescrew may include a tapered wedge portion.

As illustrated in FIGS. 2-6 and 16, the articulating joint 108 includesat least one ball and socket joint. In the illustrated embodiment thearticulating joint 108 includes two ball and socket joints, a firstjoint 116 and a second joint 118, which may be, for example, a proximaljoint 116 and a distal joint 118. An exploded view of the articulatingjoint 108 is illustrated in FIG. 16, wherein the proximal joint 116 isconnected to the first elongated element 104 and the distal joint 118 isconnected to the second elongated element 106. The proximal joint 116includes a first spherical ball end 138 inserted into a proximalreceptacle 142. The first spherical ball end 138 may be, for example, aproximal ball. The proximal receptacle 142 includes a first member 144fastened to a second member 146 to create a receptacle cavity 148. Adistal end 105 of the first elongated element 104 may be secured betweenthe first member 144 and the second member 146 to form a proximal end ofthe receptacle cavity 148. The first spherical ball end 138 may also besecured between the first member 144 and the second member 146 andslidingly engage the distal end 105 of the first elongated element 104.The fastening mechanisms used to secure the first member 144 and secondmember 146 may include snap fit fasteners, although other low profilefasteners are also contemplated. The snap fit fasteners includeprotrusions 152 and openings 154, in the depicted embodiment there arefour protrusions 152 and four openings 154. The first spherical ball end138 is coupled to a distal receptacle 140. The first spherical ball end138 may be attached to a receptacle cavity 128 of the distal receptacle140 created when a receptacle cover 130 is secured to the receptaclecavity 128.

The distal joint 118 includes a second spherical ball end 124 attachedto a third spherical ball end or bearing member 126. The secondspherical ball end 124 may be, for example, a distal ball. The terms“third spherical ball end” and “bearing member” may be usedinterchangeably herein. The second spherical ball end 124 and thebearing member 126 may be coupled together. The distal joint 118 alsoincludes a receptacle cavity 128 for receiving the second spherical ballend 124 and a receptacle cover 130 for securing the second sphericalball end 124 in the receptacle cavity 128. The receptacle cover 130 issecured to a surface surrounding the receptacle cavity 128 to form areceptacle 140 using fasteners, such as press fit inserts, not shown,inserted into openings 150. The receptacle cavity 128 may include arounded socket 128 adapted to receive the second spherical ball end 124inside the receptacle 140. Further the distal joint 118 includes a pivotend or hinge member 132 on the second elongated element 106 which isinserted into an opening 134 in the bearing member 126. The terms “pivotend” and “hinge member” may be used interchangeably herein. A pivot pin136 is inserted through the bearing member 126 and pivot end 132 tosecure the second elongated element 106 to the distal joint 118. Thepivot end 132 and pivot pin 136 form a pivot assembly.

Referring now to FIGS. 7-9, and with continued reference to FIGS. 1-6and 16, the motion of the articulating joint 108 and the relatedangulations between the first elongated element 104 and second elongatedelement 106 are shown. The depicted articulating joint 108 is formed bytwo ball and socket joints, specifically, a proximal joint 116 and adistal joint 118. The proximal joint 116 allows the receptacle 140 tomove polyaxially with respect to the proximal receptacle 142 and theconnected first elongated element 104, and vice versa. In addition, thedistal joint 118 allows the bearing member 126 to move polyaxially withrespect to the distal receptacle 140, and vice versa. Further, thedistal joint 118 allows the second elongated element 106 to movepolyaxially with respect to the receptacle 140, and vice versa. The term“polyaxial” or “polyaxially,” as used herein, refers to the ability of afirst element to pivot or move in multiple planes with respect to asecond element which the first element is coupled to. The receptacle 140and the proximal receptacle 142 can pivot in multiple planes withrespect to one another. The receptacle 140 and the second elongatedelement 106 can also move in multiple planes with respect to oneanother. The articulating joint 108 enables the first elongated element104 and second elongated element 106 to pivot in multiple planes withrespect to each other at both the proximal joint 116 and the distaljoint 118.

As illustrated in FIGS. 2-4 and 7-9, the second elongated element 106can pivot with respect to the first elongated element 104, and viceversa, in, for example, the sagittal plane at the proximal joint 116, asshown by arrows AP in FIG. 7.

As depicted in FIGS. 5 and 10, the second elongated element 106 canpivot with respect to the first elongated element 104, and vice versa ina medial-lateral plane at the proximal joint 116, as shown by arrows MLin FIG. 10. In addition, the first elongated element 104 can rotate withrespect to the second elongated element 106, and vice versa, at theproximal joint 116, as seen in FIG. 6. The second elongated element 106can also rotate with respect to the first elongated element 104, andvice versa, at the distal joint 118, as illustrated in FIG. 14. FIG. 11shows, the second elongated element 106 pivoting from a first positionto a second position with respect to the first elongated element 104 ina sagittal plane at the distal joint 118. The second elongated element106 can further pivot with respect to the first elongated element 104,and vice versa, in a medial-lateral plane at the distal joint 118, asillustrated in FIG. 12. As seen in FIG. 13, the second elongated element106 may also pivot in a 180° range with respect to the receptacle 140,and vice versa. Since the second elongated element 106 rotates withrespect to the receptacle 140, the second elongated element 106 may bemoved in any direction.

An exploded view of the articulating joint 108 is shown in FIG. 16. Adistal end of the first elongated element 104 coupled with the firstmember 144 and the second member 146 forms a receptacle cavity 148. Thefirst spherical ball end 138 is adjacent to the receptacle cavity 148.The first spherical ball end 138 sits within the receptacle cavity 148formed when the first member 144 and the second member 146 are attachedtogether securing the distal end of the first elongate member 104 to thefirst and second members 144, 146. The first spherical ball end 138 isattached to the receptacle cavity 128 which has a generally cylindricalexterior. The receptacle cavity 128 mates with the second spherical ballend 124 which is attached to a bearing member 126. The second sphericalball end 124 is secured in the receptacle 140 by attaching thereceptacle cover 130 to the receptacle cavity 128. The receptacle cover130 is secured to the receptacle cavity 128 using fasteners, such aspress fit inserts or the like, inserted into the openings 150. Thesecond spherical ball end 124 is attached to the bearing member 126, inthe depicted embodiment, for example, by a rod 156. In the depictedembodiment, the receptacle cover 130 passes over the bearing member 126in order to secure the receptacle cover 130 to the receptacle cavity128. The bearing member 126 includes a center opening 134 which mateswith the pivot end 132 of the second elongated element 106.

The proximal receptacle 142 includes an enlarged opening 158, as shownin FIG. 14, which retains the first spherical ball end 138 and allowsthe receptacle 140 to pivot polyaxially through 360° of motion relativeto the proximal receptacle 142 and the first elongated element 104,while being captively contained in the proximal receptacle 142. Theenlarged opening 158 has a diameter smaller than the diameter of thefirst spherical ball end 138. The receptacle 140 includes an enlargedopening 160, as shown in FIG. 14, which retains the second sphericalball end 124 and allows the bearing member 126 to move polyaxiallythrough 360° of motion relative to the receptacle 140 and the firstelongated element 104, while being captively contained in the receptacle140. The enlarged opening 160 has a diameter smaller than the diameterof the second spherical ball end 124. The pivot end 132 pivots at least180° relative to the bearing member 126 within the openings 134 allowingthe second elongated element 106 to be pivoted at least 180° relative tothe first elongated element 104. The pivot end 132 has a diameter thesame size or smaller than the diameter of opening 134.

Locking screws 110, 112, and 114, as shown in FIGS. 1 and 16, may beused to lock the components of the articulating joint 108 in the desiredposition. The locking screw 110 secures the first spherical ball end 138in the desired position. The locking screw 112 secures the secondspherical ball end 124 in the desired position. While locking screw 114secures the pivot end 132 in the desired position. The locking screws110, 112, and 114 may include external threads that engage internalthreads in passages 162, 164, and 166, respectively. As such, lockingscrews 110, 112, and 114 may be movable in passages 162, 164, and 166 bythreading the screws 110, 112, and 114 into the passages 162, 164, and166 and axially rotating the screws 110, 112, and 114. The passages 162,164, and 166 extend into the receptacle cavity 148, the receptaclecavity 128, and the opening 134, respectively. Locking screws 110, 112,and 114 are movable in passages 162, 164, and 166, respectively, betweena locked position and an unlocked position.

In the locked position, as seen in FIGS. 2-4 and 7-9, the locking screw110 (see FIGS. 7-9) engages the first spherical ball end 138 (see FIGS.7-9), the locking screw 112 (see FIGS. 1 and 16) engages the secondspherical ball end 124 (see FIG. 16), and the locking screw 114 (seeFIGS. 1 and 16) engages the pivot pin 136 (see FIG. 16). When thelocking screw 110 engages the first spherical ball end 138 in the lockedposition, the locking screw 110 compresses the first spherical ball end138 in the receptacle cavity 148 (see FIGS. 7-9). When the locking screw112 engages the second spherical ball end 124 in the locked position,the locking screw 112 compresses the second spherical ball end 124 inthe receptacle cavity 128 (see FIG. 16). When the locking screw 114engages the pivot pin 136 in the locked position, the locking screw 114compresses the pivot pin 136. In these compressed conditions, frictionalforces between the first spherical ball end 138, screw 110, andreceptacle cavity 148 immobilize the ball end and prevent it frommoving, so that the first elongated element 104 of rod 102 is locked inposition relative to the receptacle 140. The frictional forces betweenthe second spherical ball end 124, the screw 112, and receptacle cavity128 immobilize the second spherical ball end 124 and prevent it frommoving, so that the bearing member 126 is locked in position relative tothe receptacle 140. The frictional forces between the bearing member126, the screw 114, and the pivot end 132 immobilize the pivot end 132and prevent it from pivoting, so that the second elongated element 106of rod 102 is locked in position relative to the bearing member 126.

In the unlocked position, as shown in FIGS. 5-6 and 10, the lockingscrew 110 (see FIGS. 1 and 16) is positioned in the first passage 162(see FIGS. 1 and 16) out of contact with the first spherical ball end138 (see FIG. 16), leaving the first spherical ball end 138 free to movein the receptacle cavity 148 (see FIG. 16). This allows the receptacle140 to move polyaxially relative to the proximal receptacle 142 and thefirst elongated element 104. In the unlocked position, as seen in FIGS.11-12 and 14, the locking screw 112 (see FIGS. 12 and 14) is positionedin the second passage 164 (see FIG. 16) out of contact with the secondspherical ball end 124 (see FIG. 16), leaving the ball end 124 free tomove in the receptacle cavity 128 (see FIG. 16). This allows the bearingmember 126 (see FIG. 16) and the second elongated element 106 to pivotpolyaxially relative to the receptacle 140 and the first elongatedelement 104. In the unlocked position, as shown in FIG. 13, the lockingscrew 114 (see FIG. 16) is positioned in the third passage 166 (see FIG.16) out of contact with the pivot pin 136 (see FIG. 16), leaving thepivot end 132 free to move in the opening 134 (see FIG. 16). This allowsthe second elongated element 106 to pivot relative to the bearing member126 (see FIG. 16).

In an alternative locking arrangement, the locking screws 110, 112, and114, may be replaced with locking screws which include wedge portions,not shown, which extend into the receptacle cavity 148, receptaclecavity 128, and opening 134, respectively, and engage the firstspherical ball end 138, ball end 124, and pivot end 132. The lockingscrews with the wedge portions will lock and unlock the first sphericalball end 138, ball end 124, and pivot end 132 with respect to thereceptacle cavity 148, receptacle cavity 128, and opening 134,respectively, as discussed above with reference to locking screws 110,112, and 114. Further alternative locking elements may be used in placeof the locking screws 110, 112, and 114 and the alternative lockingelements can be non-threaded elements, such as a simple shim which isphysically pushed into the receptacle cavity 148, receptacle cavity 128,and opening 134 against the first spherical ball end 138, ball end 124,and a pivot end 132, respectively, to prevent the first spherical ballend 138, ball end 124, and a pivot end 132 from pivoting in thereceptacle cavity 148, receptacle cavity 128, and opening 134. Thelocking elements may be removable from the receptacle cavity 148,receptacle cavity 128, and opening 134, or contained in the wall of thereceptacle cavity 148, receptacle cavity 128, and opening 134,respectively. In addition, more than one locking screw 110, 112, and 114may be used in each of the receptacle cavity 148, receptacle cavity 128,and opening 134 to secure the first spherical ball end 138, ball end124, and a pivot end 132, respectively, in the desired position.

The articulating joint 108 allows for multi-planar rotation permittingangular adjustment of the first elongated element 104 and secondelongated element 106 not only in the anterior-posterior direction andsagittal plane but also in the medial-lateral direction. Differentranges of motion may be desired in multiple directions and are possiblewith the 360° of motion at the proximal joint 116, 360° of motion at thedistal joint 118, and at least 180° of pivotal motion at the pivot end132. The range of motion for the proximal joint 116 and distal joint 118may be altered by changing the size and shape of the enlarged openings158, 160. In addition, the range of motion for the pivot end 132 may bealtered by changing the size and shape of the enlarged opening 160 oralternatively by pivoting the distal joint 118 to a different position.Further altering the enlarged openings 158, 160 to have alternativeshapes, which may be symmetrical or asymmetrical, to provide differentranges of motion is also contemplated.

The distal receptacle 140 and the proximal receptacle 142 may havevarious inner and outer geometries, dependent upon the patient and thelocation of the articulating spinal rod system 100. Moreover, the distalreceptacle 140 and the proximal receptacle 142 may include one or moregripping locations allowing for the surgeon to grasp and easily pivotthe proximal joint 116 and distal joint 114. The articulating joint 108and the rods 102 may include markings designating measurements forassisting the surgeon in adjusting the articulating joint 108 toposition the first elongated element 104 and second elongated element106 in a desired position.

While the embodiments presented have been described in use withoccipitocervical fixation assemblies, articulating spinal rod systems inaccordance with the invention may be used in a variety of applications.For example, an articulating spinal rod system can be used tointerconnect first and second rod sections that are implanted in thelumbar region of the spine. The first and second rod sections may bearranged in an offset configuration, with the articulating jointproviding the desired offset between the rod sections.

Articulating spinal rod systems in accordance with the invention canalso be used in a rod to rod connector construct. The articulatingspinal rod systems can connect an existing fusion construct withanother, to treat scoliosis, bone fractures or adjacent segment disease.The articulating spinal rod system 100 can be connected to an existingrod using the articulating assembly.

Articulating spinal rod system 100 in accordance with the invention mayalso be used in a variety of applications outside of spine surgery, suchas, for example, hip surgery, including any applications where elongatedmembers are connected to one another, or to other structures. It shouldbe understood that assemblies in accordance with the invention need notbe used with rods, as noted above. Articulating spinal rod systems 100in accordance with the invention may feature elongated elements in theform of elongated plates, shafts, or any type of elongated body member.

The articulating spinal rod system 100 allows the angle of the rods 102to be easily adjusted in multiple planes. The angular adjustment is doneby moving two articulating joints, a proximal joint 116 and a distaljoint 118, to position the second elongated element 106 in a desiredposition relative to the first elongated element 104, rather thanbending the rod in the operating room. The articulating spinal rodsystem 100 allows for the adjustment of the rod 102 without creatingnotches or other like depressions/projections in the rod material. Byadjusting the angle of the rod 102 in multiple planes, the rod 102 canbe adjusted to not only match the patient's anatomy, but also meetadditional spatial requirements necessitated by other components of thesystem or instrumentation.

FIG. 17 illustrates an articulating joint 200 shown in accordance with asecond exemplary embodiment. The articulating joint 200 includes thedistal joint 118 attached directly to first elongated element 104 at aproximal end and connected to the second elongated element 106 at thedistal end. The distal joint 118 is of the type described above withreference to articulating joint 108. The articulating joint 200 includesa receptacle 140 with an enlarged opening 160 which retains the secondspherical ball end 124 and allows the bearing member 126 to movepolyaxially through 360° of motion relative to the receptacle 140 andthe first elongated element 104, while being captively contained in thereceptacle 140. The pivot end or hinge member 132 pivots at least 180°relative to the bearing member 126 within the opening 134 allowing thesecond elongated element 106 to be pivoted at least 180° relative to thefirst elongated element 104. The articulating joint 200 allows for thesecond elongated element 106 to move polyaxially with respect to thefirst elongated element 104, and vice versa, so the two elements canpivot in multiple planes with respect to one another. Thus, the secondelongated element 106 can pivot with respect to first elongated element104 in a sagittal plane and a medial-lateral plane as well as rotate360°. In addition, the pivot end 132 allows the second elongated element106 to pivot at least 180° relative to the bearing member 126.

A second exemplary embodiment of an articulating joint 300 is depictedin FIG. 18. The articulating joint 300 includes the proximal joint 116attached to the first elongated element 104 at a proximal end andconnected to the second elongated element 106 at the distal end by aball 168. The ball 168 is inserted into the receptacle 142 created whenthe first member 144 is secured to the second member 146. The proximaljoint 116 is of the type described above with reference to articulatingjoint 108. The articulating joint 300 includes a proximal receptacle 142with an enlarged opening 158 which retains the ball 168 and allows thesecond elongated member 106 to pivot polyaxially through 360° of motionrelative to the proximal receptacle 142 and the first elongated element104, while being captively contained in the proximal receptacle 142. Theball 168 is coupled to the proximal end of the second elongated member106. The articulating joint 300 allows for the second elongated element106 to move polyaxially with respect to the first elongated element 104,and vice versa, so the two elements can pivot in multiple planes withrespect to one another. Thus, the second elongated element 106 move withrespect to first elongated element 104 in the sagittal plane andmedial-lateral plane, as well as rotate 360°.

Referring now to FIGS. 19 and 20, the articulating spinal rod system 100may include a first elongated element 170 connected to a first bone oranatomical region 172 and a second elongated element 174 connected to atleast one vertebrae of the spine 176. As illustrated, an occipital plate122 is secured to the first bone 172 using fasteners 178. The occipitalplate 122 may be any occipital plate 122 which allows for the attachmentof two rods 102. The first elongated elements 170 are coupled to theoccipital plate 122 at a proximal end and to the articulating joint 108at a distal end. The second elongated elements 174 are coupled to thearticulating joint 108 at a proximal end and to a plurality of screwassemblies 120 at a distal end. The screw assemblies 120 are fastened toat least one second vertebrae 176. In the depicted embodiment the firstbone 172 is the patient's skull and the at least one vertebrae of thespine 176 is the cervical spine. The screw assemblies 120 are attachedto the spine 176 at C2 through C7.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention. Asused herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprise” (andany form of comprise, such as “comprises” and “comprising”), “have” (andany form of have, such as “has”, and “having”), “include” (and any formof include, such as “includes” and “including”), and “contain” (and anyform of contain, such as “contains” and “containing”) are open-endedlinking verbs. As a result, a method or device that “comprises,” “has,”“includes,” or “contains” one or more steps or elements possesses thoseone or more steps or elements, but is not limited to possessing onlythose one or more steps or elements. Likewise, a step of a method or anelement of a device that “comprises,” “has,” “includes,” or “contains”one or more features possesses those one or more features, but is notlimited to possessing only those one or more features. Furthermore, adevice or structure that is configured in a certain way is configured inat least that way, but may also be configured in ways that are notlisted.

The invention has been described with reference to the preferredembodiments. It will be understood that the architectural andoperational embodiments described herein are exemplary of a plurality ofpossible arrangements to provide the same general features,characteristics, and general system operation. Modifications andalterations will occur to others upon a reading and understanding of thepreceding detailed description. It is intended that the invention beconstrued as including all such modifications and alterations.

1-20. (canceled)
 21. An articulating joint assembly, comprising: a firstelongated element; a receptacle coupled to an end of the first elongatedelement; a pivoting member configured to be received within thereceptacle; and a second elongated element coupled to the pivotingmember.
 22. The articulating joint assembly of claim 21, wherein thereceptacle comprises: a first member; and a second member coupled to thefirst member to form a cavity; wherein the cavity is configured to allowfor movement of the pivoting member with respect to the receptacle. 23.The articulating joint assembly of claim 22, wherein the pivoting membercomprises: a ball end.
 24. The articulating joint assembly of claim 23,wherein the pivoting member further comprises: a bearing member coupledto the ball end; and a pivot assembly coupled to the bearing member. 25.The articulating joint assembly of claim 24, wherein the pivot assemblycomprises: a hinge member; and a pivot pin, wherein the pivot pinengages the hinge member and the bearing member to couple the hingemember to the bearing member and allow for pivotal movement of the hingemember with respect to the bearing member.
 26. The articulating jointassembly of claim 25, wherein the second elongated element is coupled tothe hinge member.
 27. The articulating joint assembly of claim 21,further comprising: at least one locking mechanism to secure thepivoting member to the receptacle.
 28. An articulating joint system,comprising: an articulating joint assembly including at least onearticulating joint, the at least one articulating joint comprising: areceptacle, comprising: a first member; and a second member coupled tothe first member to form an opening; and a pivoting member, comprising:a spherical shaped end configured to be received within the opening ofthe receptacle; a bearing member coupled to the spherical shaped end andextending away from the opening of the receptacle, the bearing memberincluding a center opening; and a hinge member coupled to the bearingmember and received within the center opening; a plate; and at least onerod coupling the articulating joint assembly to the plate.
 29. Thearticulating joint system of claim 28, wherein the at least onearticulating joint comprises: a first articulating joint; and a secondarticulating joint.
 30. The articulating joint system of claim 29,wherein the at least one rod comprises: a first rod, comprising: a firstelongated element coupled to the plate at a first end and the firstarticulating joint at a second end; and a second elongated elementcoupled to the first articulating joint at a first end and at least onefastener at a second end; wherein the first elongated element coupled toa first side of the first articulating joint and the second elongatedelement is coupled to a second side of the second articulating joint,and wherein the first side is opposite the second side; and a secondrod, comprising: a first elongated element coupled to the plate at afirst end and the second articulating joint at a second end; and asecond elongated element coupled to the second articulating joint at afirst end and at least one fastener at a second end; wherein the secondelongated element is coupled to a first side of the first articulatingjoint and the second elongated element is coupled to a second side ofthe second articulating joint, wherein the first side is opposite thesecond side.
 31. The articulating joint system of claim 30, wherein thefirst elongated element of the first rod is angled at a point betweenthe first end and the second end of the first rod; and wherein the firstelongated element of the second rod is angled at a point between thefirst end and the second end of the second rod.
 32. The articulatingjoint system of claim 28, wherein the at least one articulating jointfurther comprises: a second spherical shaped end coupled to thereceptacle on a side opposite the opening; and a second receptaclecomprising: a first member; and a second member coupled to the firstmember to form a cavity; wherein the cavity receives and couples thesecond spherical shaped end to a first elongated element of the at leastone rod to allow for movement between the second spherical shaped endand the first elongated element.
 33. The articulating joint system ofclaim 28, wherein the first member of the receptacle comprises areceptacle cavity; and wherein the second member of the receptaclecomprises a receptacle cover, the receptacle cover couples to thereceptacle cavity to form the opening for receiving the spherical shapedend.
 34. The articulating joint system of claim 28, wherein the pivotingmember further comprises: a pivot pin, wherein the pivot pin couples thehinge member to the bearing member and allows for pivotal movement ofthe hinge member with respect to the bearing member in an unlockedposition.
 35. The articulating joint system of claim 28, wherein thepivoting member further comprises: a rod with a first end and a secondend, wherein the first end of the rod is coupled to the spherical shapedend and the second end of the rod is coupled to the bearing member. 36.The articulating joint system of claim 28, wherein the at least onearticulating joint further comprises: at least one first lockingmechanism coupled to the receptacle and engages the spherical shaped endto lock the receptacle in position with respect to the spherical shapedend; and at least one second locking mechanism coupled to the hingemember and engages the pivot pin.
 37. The articulating joint system ofclaim 32, wherein the at least one articulating joint further comprises:at least one first locking mechanism coupled to the receptacle andengages the spherical shaped end to lock the receptacle in position withrespect to the spherical shaped end; at least one second lockingmechanism coupled to the hinge member and engages the pivot pin; and atleast one third locking mechanism coupled to the second receptacle andengages the second spherical shaped end.
 38. The articulating jointsystem of claim 30, the articulating joint assembly further comprising:a first movable orientation, wherein the second elongated element of thefirst rod moves polyaxially through 360° of motion relative to the firstelongated element of the first rod, and the second elongated element ofthe second rod moves polyaxially through 360° of motion relative to thefirst elongated element of the second rod, and wherein the hinge memberpivots at least 180° relative to the bearing member; and a second lockedorientation, wherein the second elongated element of the first rod isfixed relative to the first elongated element of the first rod, andwherein the second elongated element of the second rod is fixed relativeto the first elongated element of the second rod.
 39. The articulatingjoint system of claim 28, wherein the plate comprises: at least oneopening for receiving a fastener to couple the plate to a bone.
 40. Thearticulating joint system of claim 28, wherein the plate is an occipitalplate.